Advance Directives: Take Charge of Your Health Care

Updated on February 8, 2013

Living Wills and Advance Decisions Only Count When They Are in Writing

Advance Directives Put You in Charge

Advance directives are legal documents that allow any competent person to determine ahead of time what medical treatment you want and don't want in the event you are too ill or injured to communicate with medical personnel. No one is mandated to complete advance directives, but many people decide to do so.

There are two basic types of advance directives: a Living Will and a Durable Power of Attorney for Health Care. You can complete one or the other, both, or neither--it's entirely up to you. Aliving will allows you to spell out what types of medical treatments you want or don't want should you be unable to communicate that in a end-of-life situation. A durable power of attorney for health care is a person to whom you give the power to make medical decisions on your behalf should you be unable to do so.

Some people find it empowering to be able to make their wishes known ahead of time, much the same as completing a traditional will that explains what to do after their death. The living will covers such things as respirators and ventilators, tube feedings, resuscitation if you stop breathing or your heart stops beating and organ donation. If you say yes to one, you can say no to any other; it is not an "all or nothing" type of document.

The people who care about you will be relieved of having to make decisions for you, should you complete an advance directive. Some families and friends do talk about such things and it would seem easy enough in such a situation for someone to tell the physician you did not want one or more life-saving measures. But that person is also someone who would be under emotional stress at the time due to your condition and may be reluctant to express your wishes, especially if you want nothing done to extend your life. Completing an advance directive removes a potential burden to your loved ones and assures that whatever you wanted will be the thing done or not done.

If you are unsure about completing the paperwork, have questions or concerns, or would simply feel more at ease with having guidance from a reliable and knowledgeable resource, look to an elder care attorney, or an elder care case manager -- usually a registered nurse or social service worker with experience in such areas.

The time to complete an advance directive/advance decision is before a crisis occurs. | Source

What an Advance Directive for Health Care/Living Will Is Not

An advance directive, while a legal document, does not require an attorney. You may wish to speak with your attorney or a social service person, hospital patient advocate or your health care provider before completing an advance directive, but it is not necessary for you to do so.

An advance directive is NOT an avenue to euthanasia or a signal to health care providers to give less than adequate care to you. An advance directive only comes into play if you are unable to make your wishes known and are in a life-or-death or terminal situation as determined by at least two independent physicians who must document their findings on your medical status.

Insurance companies are forbidden to exclude you from insurance coverage due to the existence or non-existence of an advance directive.

Advance directives are not only for senior citizens, but for persons of any age that wish to take control of such decisions. No one likes to consider it, but traffic accidents, work accidents and some diseases put people of all ages into situations where an advance directive of one type or another might be useful.

Advance directives are not binding for life. You can change your mind at any time about anything in a living will or nullify the living will or durable power of attorney for health care. In any of these events, make sure to give new copies or destroy altogether copies given to health care providers, family members or anyone else.

What to do with an Advance Directive

If you've decided to complete as advance directive, be sure to follow the laws of your state as to whether your signature needs to be notarized or if witness signatures are necessary. In Oklahoma, for example, two witnesses are required for your signature, but they cannot be anyone who stands to gain from your will or from disbursement of your assets if you die intestate. Advance directives by state may be found here.

Make copies of the form and provide them to your health care provider, family members, attorney or anyone who would be contacted in the event something happened to you. Keep track of the people who have a copy, should you make changes or withdraw the advance directive altogether. That way you can ensure no erroneous copies will exist.

More Information on Advance Directives, Health Care Power of Attorney and Living Wills

What Happens if No Advance Directive is Available?

In general, health care personnel will first check to see if a living will has been completed. If not, then they will determine if a durable power of attorney for health care has been designated. If not, health care personnel will determine if the patient made any statements verbally or in writing to their knowledge about what type of medical treatment they would or wouldn't want.

Lacking such evidence, family and friends of the patient would be contacted to learn if they patient provided them with any such information. Lacking a consensus or definite direction, medical personnel would be required to provide any and all care as required by the patient condition, including ventilators, feeding tubes and the like. In the end, the court may be petitioned to name a guardian for the patient who can make medical decisions on his or her behalf.

Interestingly, as noted in research appearing in a 2011 "Annals of Family Medicine," family or friends who must make decisions about life-sustaining treatment in the absence of advance directives most often opt for the use of any and all available treatments to sustain the life of the injured or ill person. This is particularly true if the patient has not even informally talked to family or friends about what her wishes would be in such a situation.

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I welcome your comments... 13 comments

Pancho 24 months ago

Our Wedding is about 4months away and i have been trying to get my fceaine to like forgo the Traditional first dance because for one i can't dance worth a flip and two i don't really want to do it in front of 250 people =/. I have been trying to convince my fceaine to get rid of it since we began planning the wedding but she is making a huge deal out of it for some reason and i don't understand. I have been letting her make this wedding into her special/dream wedding but seriously why can't she do this one thing for me? Advice?

Ali 24 months ago

are they lookin to do an acutal routine? like waltz and stuff? or are they just dancing to the music?Some of my favorite country songs that i would want at my wedding are:~Lost in this moment (Big Rich) (I guess the counts kind of work for international fox trot if you want something more classy rather than just country 2-step)~She's Everything (Brad Paisley)~(this one's my favorite) The Woman In My Life (Phil Vassar) it's the perfect song for an elegant waltz ~We danced (Brad Paisley)~Almost any song from Michael Buble is perfect for a wedding and completely dance-able but he's not country ~I know some other songs too that are perfect for weddings but they're not country..so if you're still interested let me know!Hope this helped!

Healthexplorer 3 years ago

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L.L. Woodard 3 years ago from Oklahoma City Author

Gsidley, I appreciate the additional information you've provided. I'm going to have to take a closer look at mental health advance directives in the U.S. I know that in most states, a person is considered to be competent until they've been adjudicated otherwise, but wonder if certain mental health diagnoses are gray areas or not.

Thank you. Much food for thought here.

gsidley 3 years ago from Lancashire, England

There is some literature about advance directives being used within the American psychiatric system. Although advance directives fit perfectly with what a modern mental health service is supposed to be about (person-centred, empowerment of service users, recovery approach etc) there are barriers, not least the "doctor knows best attitude."

You're right in saying that the some may question whether the service-user was of sound mind (or had capacity) when the advance directive was composed. In the UK a piece of legislation (Mental Capacity Act 2005) dictates that everyone should be assumed to have capacity until it is proven otherwise, so the capacity question should not be an insurmountable barrier to using advance directives/decisions.

Best wishes.

L.L. Woodard 3 years ago from Oklahoma City Author

Gsidley, what a compassionate and useful method to allow those with mental illness to have some say in their care when they are incapacitated. I don't know anything about legalities in the United Kingdom, but in the United States, I can envision some problems with being able to prove the affected person was indeed of sound mind when the advance decision was signed.

I hope your idea gains momentum there and finds its way to this side of the pond.

gsidley 3 years ago from Lancashire, England

An interesting hub.

In the United Kingdom the equivalent tool is referred to as an "advance decision." As well as being relevant for end-of-life care, as a mental health professional I am trying to promote the use of advance decisions in the psychiatric field. For example, for someone who suffers recurrent episodes of psychosis, an advance decision (validly composed) can communicate which specific intervention/medication should not to be given should the person lose capacity again in the future. As such, an advance decision can offer a mental health service user some influence over future psychiatric provision.

L.L. Woodard 4 years ago from Oklahoma City Author

Peggy W, I so appreciate your comment and will check out your hub too.

I am certain there is an approach that would reach adults of any age, but I don't think it has yet been found. The only folks I know who become true believers are those family and friends of a person who becomes gravely ill without any advance directives in place.

Terry Schiavo's incidence, may she rest in peace, should have been able to bring the message home, but I think it got lost in the legal shuffle.

Thanks for SHARING.

Peggy W 4 years ago from Houston, Texas

This is SO IMPORTANT and for some reason many people shy away from making these decisions. I have also written about the need for living wills and having seen the results in hospitals regarding people who did not have them in place...I made sure that this was done when I was still in my 20's! It is never too early to prepare for things like this and the necessity of a living will and/or advanced directive could come into play at any age. Not everyone dies of old age!

Voting this useful and will share with my followers.

L.L. Woodard 5 years ago from Oklahoma City Author

Thanks for the read, MrTrustStore.

MrTrustStore 5 years ago from Oxnard & Santa Clarita, CA

Very nice hub!

L.L. Woodard 5 years ago from Oklahoma City Author

Abigayle Lee, thank you for your thoughtful comment. I hope there is no need to put any of your advance directives into use any time soon, but it must be a bit reassuring to have put such things in order. It's not something that anyone looks forward to doing, but one of those things that provide peace of mind later on.

You make a good point about being careful about who you choose as a power of attorney, whether it be for health care or finances. People do change if there's money in the wind, and not always for the better.

Abigayle Lee 5 years ago

I have to say doing all the necessary legal paperwork before a soldier deploys is a bit depressing and this is one of the documents they ask for you to do. Truth be told the only person I truly and without a doubt trust to make a decesion of that magnitude is my father but just in case I made it for both my spouse and father and they have to make a choice together. I also have made my wishes clear in writing in those documents as well. My ex-husband, and best friend, also has a third say if there is a disagreement he makes the final say and he has all copies and the only one with the key to the safe where all the documents are held. He also will fill in the spot of the spouse if i get a divorce and is taking my fourth child with the man I am already divorcing since he doesn't do anything with him. I think not one person should ever make those kinds of choices for us because in the end we don't know what their true motivations are and just like with a power of attorney; we need to be careful who we trust with that. I have seen people do some really awful things to others with that kind of power you wouldn't think would do it. When its your life on top of it; I would just say be careful and have all your wishes in writing in a legal binding document and do it when your young and your family is started. YOu never know when the end will be and if today is your last day.